Provider Demographics
NPI:1962744474
Name:SPERBER, BRIAN DANIEL (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DANIEL
Last Name:SPERBER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216-1602
Mailing Address - Country:US
Mailing Address - Phone:920-388-5200
Mailing Address - Fax:
Practice Address - Street 1:1112 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-1602
Practice Address - Country:US
Practice Address - Phone:920-388-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7073-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist